NPIMap

Organization Active NPI

County of Clay

Doing business as CCH Medical Clinic

  • Rural Health Clinic/Center
  • Flora, IL
National Provider Identifier
1811946411
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COUNTY OF CLAY
Doing business as
CCH Medical Clinic
Practice address
929 Stacey Burk Dr
Flora, IL 62839-3241
Phone
(618) 662-2191
Fax
(618) 662-1482
NPI assigned
May 9, 2006
Last updated
Sep 17, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
COUNTY OF CLAYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Carrie Miller
Title
Chief Nursing Officer
Phone
(618) 662-2131

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

929 Stacey Burk Dr
Flora, IL 62839-3241

Mailing address

PO Box 280
Flora, IL 62839-0280
Phone (618) 662-2131

Other names 1

  • CCH Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040322000969 IL Part B Supplier - Clinic/Group Practice 0042101982 Receives reassigned benefits from 22 practitioners
1 other NPI on this enrollment
Practice locations: Clay City, IL; Flora, IL; Louisville, IL
O20100830000476 IL Part A Provider - Rural Health Clinic 0042101982 Practice locations: Flora, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811946411. Details of each certification follow.

Rural health clinic certification: CCN 143458

Legal name
COUNTY OF CLAY
Doing business as
CCH MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 29, 2001
Last certification
Jun 26, 2026
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
929 Stacy Burk Dr
Flora, IL 62839-3241
Related CCNs
141351

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0934419CCH Medical Clinic929 Stacy Burk Drive, Flora, IL 62839Certificate of waiverSep 24, 2026

National Provider Directory

National Provider Directory
Part of
County of Clay

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

939 Sunset Rd SW
Clay City, IL 62824

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
County of Clay Organization, Louisville, IL 5% Or Greater Direct Ownership Interest Mar 1, 2010 100%
Ariane Souder Individual Operational/Managerial Control Dec 23, 2013
Jody Gillum Individual W-2 Managing EmployeeAd; Oct 13, 2022

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • County of Clay

    dba Clay County Hospital

    • Critical Access Hospital
    • Flora, IL
    • NPI 1184655136

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Clay

    dba CCH Pharmacy

    • Community/Retail Pharmacy
    • Flora, IL
    • NPI 1235990276

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Clay

    dba Clay County Hospital

    • Medicare Defined Swing Bed Hospital Unit
    • Flora, IL
    • NPI 1336345578

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Clay

    dba Louisville Medical Clinic

    • Rural Health Clinic/Center
    • Louisville, IL
    • NPI 1831120401

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Clay
    • Rural Health Clinic/Center
    • Clay City, IL
    • NPI 1871950550

    5% Or Greater Direct Ownership Interest

    CMS ownership

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Clay County HospitalFlora, IL, CCN 141351 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Clay County HospitalFlora, IL, CCN 14Z351 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Louisville Medical ClinicLouisville, IL, CCN 143487 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2006
Clay City Medical ClinicClay City, IL, CCN 148558 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2016

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • County of Clay

    dba Clay County Hospital

    • Critical Access Hospital
    • Flora, IL
    • NPI 1184655136

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Clay

    dba Clay County Hospital

    • Medicare Defined Swing Bed Hospital Unit
    • Flora, IL
    • NPI 1336345578

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Clay

    dba Louisville Medical Clinic

    • Rural Health Clinic/Center
    • Louisville, IL
    • NPI 1831120401

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • County of Clay
    • Rural Health Clinic/Center
    • Clay City, IL
    • NPI 1871950550

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 118

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 118

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631836800000",
    "number": "1811946411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 280",
            "city": "FLORA",
            "state": "IL",
            "postal_code": "628390280",
            "telephone_number": "618-662-2131",
            "fax_number": "618-662-1482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 STACEY BURK DR",
            "city": "FLORA",
            "state": "IL",
            "postal_code": "628393241",
            "telephone_number": "618-662-2191",
            "fax_number": "618-662-1482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF CLAY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF CLAY",
        "enumeration_date": "2006-05-09",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_title_or_position": "CHIEF NURSING OFFICER",
        "authorized_official_telephone_number": "618-662-2131",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCH Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CCH Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flora, IL

Sources for this page

Verify at the official NPI Registry.